Intermenstrual bleeding
The menstrual cycle is basically normal, but when periodic bleeding occurs in the outline group between periods, it is called “intermenstrual bleeding”.
This disease is equivalent to ovulatory bleeding in Western medicine. If the bleeding period is long and the blood volume increases, and if it is not treated in time, further development may lead to leakage.
Etiology and pathogenesis
The middle menstrual period, also known as the syndromic period, is a physiological stage in which the yin essence of the flush is full and the yin energy is gradually growing, transforming from yin to yang. If the kidney yin is deficient, the spleen qi is weak, damp heat disturbs or blood stasis obstructs, the transformation of yin and yang is not coordinated, and the disease occurs. The common subtypes are kidney yin deficiency, spleen qi deficiency, damp-heat and blood stasis.
I. Kidney Yin deficiency
The deficiency of yin in the kidney and the deficiency of essence and blood in the kidney, the deficiency of yin and heat in the kidney, and the heat in the rushing of blood.
Spleen Qi deficiency
The spleen qi is weak, and the rushing of the spleen is not solid, so when the outline is set, the yang qi moves inside, but the yang qi is not enough, and the blood loses its control, so the bleeding stops.
Damp-heat
Damp-heat is caused by external damp-heat, or by emotional injury, liver depression and spleen, water and dampness are generated within the body, and damp-heat is intertwined with each other, and is contained in the ramifications.
Blood stasis
After menstruation and childbirth, the residual blood stays in the body, and the blood from the menstruation is stored as stasis, or the emotion is injured, the Qi is depressed and the blood is knotted, which becomes stasis for a long time.
Diagnosis and treatment
This disease is more accurately analyzed by taking the small amount of uterine bleeding that occurs in the syndromic period as the main point of identification. Treatment is based on regulating the balance of yin and yang of the flush, and using prescriptions to nourish kidney yin, tonify spleen qi, relieve dampness and heat or eliminate blood stasis.
1. Kidney yin deficiency type
Main symptoms: intermenstrual bleeding with small amount, bright red color, thick texture, dizziness and tinnitus, soreness and weakness of the waist and legs, heat in the hands and feet, restless sleep at night, red tongue, little coating, and fine pulse.
Analysis of the symptoms: Kidney yin deficiency, heat in the ramus, in the syndromic period, yang energy moves inside, yang energy multiplies yin, forcing blood to move delusively, so bleeding occurs; yin deficiency and internal heat, so bleeding is small, bright red and thick; kidney bones produce marrow, kidney yin deficiency, brain marrow loss of nourishment, so dizziness and tinnitus; kidney deficiency is the loss of nourishment of the outer body, so the waist and legs are sore and weak; yin deficiency and internal heat, so the hands and feet and heart are hot; kidney water deficiency, can not help the heart, so sleepless at night. A red tongue with little coating and thin pulse is also a sign of kidney yin deficiency.
Treatment: Nourishing the kidney and benefiting Yin, consolidating the flushing and stopping bleeding.
Example of formula: Add and reduce Consistent Decoction (Jing Yue Quan Shu).
Radix Rehmanniae Praeparata, Radix Paeoniae Alba, Radix Rehmanniae Praeparata, Radix Glycyrrhiza Uralensis, Radix Ginseng, Radix Rehmanniae Praeparata
In this formula, Sheng Di, Shu Di and Zhi Mu nourish the kidneys and benefit Yin; Di Bone Peel diodes Yin fire; Bai Shao harmonizes Blood and astringes Yin; Mai Dong nourishes Yin and clears the heart; Gan Cao harmonizes all medicines. The whole formula together can nourish the kidneys and benefit yin, consolidate flushing and regulate menstruation, so bleeding can be stopped.
In case of dizziness and tinnitus, add mother-of-pearl and oyster; in case of restless sleep at night, add Yuan Zhi and nightshade; in case of bleeding, add dry lotus grass, fried ground elm and panax ginseng.
2.Spleen qi deficiency type
Main symptoms: intermenstrual bleeding with small amount, color, thin texture, fatigue, shortness of breath, lazy speech, abdominal distension with little food, light tongue, thin coating, slow and weak pulse.
Analysis of the symptoms: Spleen Qi is weak, the flush is not solid, in the Shao group period, Yang Qi is insufficient, unable to regulate Qi and blood, thus bleeding; Spleen deficiency and insufficient source of transformation, so the menstrual volume is small, light in color and thin in quality; Spleen Qi is weak, the Yang is not invigorated, so the body is tired, short of breath and lazy speech; transport and transformation failure, then less food and abdominal distension. Pale tongue, thin coating, slow and weak pulse are also signs of spleen qi deficiency.
Treatment: Strengthening the spleen and benefiting the qi, consolidating the flushing and regulating the blood.
Example of formula: Gui Shen Tang.
3. Damp-heat type
Main symptoms: intermenstrual bleeding, dark red blood, thick texture, usually yellowish in quantity, pain in the abdomen, distress and thirst, bitterness and dryness of the throat, red tongue, yellowish greasy coating, slippery pulse.
The tongue is red, the moss is yellow and greasy, and the pulse is slippery, which are also signs of damp-heat.
Treatment: Clearing heat and removing dampness, cooling the blood and stopping bleeding.
Example of formula: Clear the liver and stop the lymphatic flow of blood (Fu Qingzheng masters of female medicine), remove Agaricus, red dates, add Fu Ling, fried Diyu.
White peony, Radix et Rhizoma, Radix Angelicae Sinensis, Colla Corii Asini, Dampi, Phellodendron Bidentata, Radix Aromaticus, Red Date, Black Bean
In this formula, Phellodendron, black bean and Poria clear heat and detoxify the toxins, induce diuresis and remove dampness; Radix Aromaticus, Dampness, and Niubizi regulate blood circulation and relieve pain; Radix Angelicae Sinensis and Radix Paeoniae Alba nourish blood and soften the liver, slow down the pain; Radix et Rhizoma, fried Di Yu cool the blood and stop bleeding. The whole formula works together to clear heat and remove dampness, cool the blood and stop bleeding.
During bleeding, remove angelica, aromatic herb, hyssop, and add cyperus root and aconite bone as appropriate; if the amount of discharge is high, add amaranth, poria; if the appetite is poor or abdominal distension after eating; remove raw earth, white peony, and add thick park and malt as appropriate; if the stool is unpleasant, remove angelica, raw earth, and add coix seeds and white lentils as appropriate.
4.Blood stasis type
Main symptoms: intermenstrual bleeding with purple blood color and blood clots, pain in the abdomen and refusal to press, depression, purple and dull tongue or petechiae, astringent and strong pulse.
Analysis of the symptoms: Stasis of blood blocking the ramifications of the stroke, internal movement of Yang Qi in the syndromic group, leading to stasis of blood. The purple dull tongue or stasis points and astringent and strong pulse are also signs of blood stasis.
Treatment: Invigorate blood circulation to resolve blood stasis and regulate blood flow to the meridians.
Example of formula: Expelling Blood Stasis and Stopping Blood Stasis Tang (Fu Qingzhu Women).
Rhubarb, Radix et Rhizoma, Radix Angelicae Sinensis, Radix Paeoniae Alba, Dampi, Citrus Aurantium, Tortoise Plate, Peach kernel.
In this formula, Tao Ren, Rhubarb, Radix et Rhizoma, Radix Paeoniae, Dampi and Guiweiwei invigorate blood circulation to resolve blood stasis and induce blood to return to the meridian; Citrus aurantium shells regulate Qi and move stagnation; Shengdi and Turtle Board nourish Yin and benefit the kidney to consolidate flushing and stop bleeding. The whole formula works together to invigorate blood circulation, resolve blood stasis and regulate qi to return to the meridian.
During bleeding, remove Red Peony and Radix Angelicae Sinensis, add Panax Pseudoginseng and Fried Phellodendron at discretion; if abdominal pain is severe, add Yanhuosuo and Fragrant Herba at discretion; if heat is present, add Huang Bai and Zhi Mu at discretion.